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      Building national public health capacity for managing chemical events: A case study of the development of health protection services in the United Kingdom

      research-article
      a , * , b
      Journal of Public Health Policy
      Palgrave Macmillan
      chemical events, health protection policy

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          Abstract

          The revised International Health Regulations (2005) require that countries develop plans for chemical threats. In 2012, the World Health Assembly reported that most countries had not yet achieved ‘adequate capacity'. We review the evolution of chemical hazards services in the United Kingdom, the result of 15 years of grass-roots pressure and an accumulating weight of chemical incidents that eventually convinced the UK Department of Health of the need for a new national public health function, culminating, in 2003, in the creation of the Chemical Hazards Division of the new Health Protection Agency. Ten years later, public health services are again being radically reorganized with the creation of Public Health England, potentially destabilizing health protection arrangements and creating confusion among roles in managing chemical emergencies. Incorporating health protection into a broader public health organization, however, offers a new opportunity to broaden the scope of health protection services to embrace prevention of non-infectious environmental diseases.

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          Most cited references51

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          Health effects of dioxin exposure: a 20-year mortality study.

          Follow-up of the population exposed to dioxin after the 1976 accident in Seveso, Italy, was extended to 1996. During the entire observation period, all-cause and all-cancer mortality did not increase. Fifteen years after the accident, mortality among men in high-exposure zones A (804 inhabitants) and B (5,941 inhabitants) increased from all cancers (rate ratio (RR) = 1.3, 95% confidence interval (CI): 1.0, 1.7), rectal cancer (RR = 2.4, 95% CI: 1.2, 4.6), and lung cancer (RR = 1.3, 95% CI: 1.0, 1.7), with no latency-related pattern for rectal or lung cancer. An excess of lymphohemopoietic neoplasms was found in both genders (RR = 1.7, 95% CI: 1.2, 2.5). Hodgkin's disease risk was elevated in the first 10-year observation period (RR = 4.9, 95% CI: 1.5, 16.4), whereas the highest increase for non-Hodgkin's lymphoma (RR = 2.8, 95% CI: 1.1, 7.0) and myeloid leukemia (RR = 3.8, 95% CI: 1.2, 12.5) occurred after 15 years. No soft tissue sarcoma cases were found in these zones (0.8 expected). An overall increase in diabetes was reported, notably among women (RR = 2.4, 95% CI: 1.2, 4.6). Chronic circulatory and respiratory diseases were moderately increased, suggesting a link with accident-related stressors and chemical exposure. Results support evaluation of dioxin as carcinogenic to humans and corroborate the hypotheses of its association with other health outcomes, including cardiovascular- and endocrine-related effects.
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            Acute health effects of the Sea Empress oil spill.

            To investigate whether residents in the vicinity of the Sea Empress tanker spill suffered an increase in self reported physical and psychological symptoms, which might be attributable to exposure to crude oil. Retrospective cohort study; postal questionnaire including demographic details, a symptom checklist, beliefs about health effects of oil and the Hospital Anxiety and Depression and SF-36 mental health scales. Populations living in four coastal towns on the exposed south Pembrokeshire coast and two control towns on the unexposed north coast. 539 exposed and 550 unexposed people sampled at random from the family health services authority age-sex register who completed questionnaires. Adjusted odds ratios for self reported physical symptoms; scores on the Hospital Anxiety and Depression and SF-36 mental health scales, in 1089 people who responded out of a possible 1585 (69%). Living in areas exposed to the crude oil spillage was significantly associated with higher anxiety and depression scores, worse mental health; and self reported headache (odds ratio = 2.35, 95% CI 1.56, 3.55), sore eyes (odds ratio = 1.96, 95% CI 1.06, 3.62), and sore throat (odds ratio = 1.70, 95% CI 1.12, 2.60) after adjusting for age, sex, smoking status, anxiety, and the belief that oil had affected health. People living in exposed areas reported higher rates of physical and psychological symptoms than control areas. Symptoms significantly associated with exposure after adjustment for anxiety and health beliefs were those expected from the known toxicological effect of oil, suggesting a direct health effect on the exposed population.
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              • Article: not found

              Public health impacts of floods and chemical contamination.

              Flooding accounts for about 40 per cent of all natural disasters that occur worldwide. In 2002-2003 many counties in England experienced severe floods. Floods are particularly important in public health terms as they may have multiple environmental consequences. Details of floods reported to Chemical Hazards and Poisons Division, London [CHaPD(L)] were analysed and a literature review was undertaken to identify published reports of flood-related chemical incidents that have had an impact on public health. Epidemiological evidence shows that chemical material may contaminate homes and that in some cases flooding may lead to mobilization of dangerous chemicals from storage or remobilization of chemicals already in the environment, e.g. pesticides. Hazards may be greater when industrial or agricultural land adjoining residential land is affected. Less evidence exists to support the hypothesis that flooding that causes chemical contamination has a clear causal effect on the pattern of morbidity and mortality following these flooding events. In the light of this evidence, a checklist/pro forma for public health response to and investigation of flooding events that may result in chemical contamination was needed. This is available from CHaPD(L).
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                Author and article information

                Journal
                J Public Health Policy
                J Public Health Policy
                jphp
                Journal of Public Health Policy
                Palgrave Macmillan
                0197-5897
                1745-655X
                May 2013
                28 February 2013
                : 34
                : 2
                : 213-225
                Affiliations
                [a ]Department of Primary Care and Public Health, Cardiff University , Neuadd Meirionnydd, Heath Park, Cardiff, Wales CF14 4YS, UK
                [b ]Cardiff Metropolitan University , Western Avenue, Cardiff, Wales, CF5 2YB, UK
                Author notes
                Article
                jphp20135
                10.1057/jphp.2013.5
                3644620
                23447032
                a32358be-b21d-4606-9d48-ae3c8f846c4e
                Copyright © 2013 Palgrave Macmillan, a division of Macmillan Publishers Ltd

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivative Works 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/

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                Public health
                chemical events,health protection policy
                Public health
                chemical events, health protection policy

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